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NYAC Membership Application 2011-2012 Swimmer’s Name: _____________________________________________________ First

Group ______________


Date of Birth: day ____ month ____ year____ Gender: M


email ___________________________

(provide a copy of swimmer’s birth certificate)

(optional swimmer ‘s email address)

Address: _________________________________________________________________________________ Street Address & Suite/Unit#

_________________________________________________________________________________________ Province Postal Code City In order to communicate effectively, NYAC pool reps (group parent representatives) will regularly email information from the coaching staff and the Board of Directors to the members of their group, therefore, it is important to indicate the email address to which you’d prefer the information be sent. Mother’s Name: ___________________________

Home Phone #: ______________________

Work Phone #: ____________________________

E-mail Address: ______________________

Father’s Name: ____________________________

Home Phone #: ______________________

Work Phone #: ____________________________

E-mail Address: _____________________

Member Agreements and Waiver Clause I hereby make application for membership in the North York Aquatic Club (“NYAC” or “the Club”) and agree upon this application being accepted to become debtor to the Club for the full amount of the annual swimmer’s fees, meet fees, non-refundable administration fee, fundraising and participation assessments and non-participation assessments, together with any additional costs incurred by the member. I have read the NYAC Member Commitment and Assessment information and I understand that both the unused portions of the fundraising and points assessments are non-refundable should my child leave the program before the completion of the season. INITIAL ____ I will fulfill the meet session requirement or agree to pay the non-participation fee of $100 per session missed and give permission for NYAC to charge my credit card after the 2 week notice period. INITIAL ____ I recognize my responsibility to actively support the Club through volunteer activities. INITIAL ____ I have read the NYAC guidelines and code of conduct with my child and understand the commitments required. INITIAL ____ I, hereby give permission for my child to travel to a designated swim meets during the 2011-2012 swim season with the North York Aquatic Club by such transportation means as described in the policy. I hereby assume all risks and hazards incidental to his/her participation in this activity and I hereby waive, release, absolve, indemnify and agree to hold harmless the North York Aquatic Club, its coaches, staff, and board of directors. I acknowledge that my swimmer will not be permitted to travel unless the trip release form is received by the NYAC chaperone. Any costs incurred as a result of cancelled or additional travel will be absorbed by the member. INITIAL ____ In the event of, and in consideration of, my application being accepted, I, do hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages which I or any child included in my application may have against the North York Aquatic Club and/or the City of Toronto for injuries sustained while participating in Club activities. INITIAL ____ The acknowledgment of the member agreement and waiver clause, guidelines and code of conduct, fundraising and points assessment, meet and Swim-a-thon commitments, and transportation policy is agreed to by signing below. Signed cheques and Visa/MC Payment information is required in order to register for the 2011-2012 swim season. Parent or Legal Guardian: Signature: (Parent/Guardian or swimmer if 18 years of age at time of registration)